Monday, December 19, 2011

January 5, 2012--Linus is doing very well. He is eating great--a 5.5 oz can of food at breakfast this morning. He is peeing and pooping just fine. His blood glucose levels are good so long as he doesn't get a fur shot. (Oops!) His pre-shot level this morning, before his 2U of Lantus, was 150. I can't imagine a better report, well, maybe one that says he is OTJ!

DCIN continues to fundraise for Linus's past critical care. Linus's bill for his two nights in the critical care clinic was about $1600. (DCIN received a generous donation from the sanctuary that surrendered Linus to DCIN, but we are hoping to hold that donation for routine care over Linus's lifetime, as was suggested by the person who delivered the check to me, not eat it all up with a single day's hospitalization.) ~Venita

January 2, 2012--Don and I spoke last night. Linus's hemobartonella test came back negative. The vets now suspect that the cause of Linus's crash was a bad reaction to the clavamox he had received because of a URI in his previously living situation. (To me, that cause seems pretty distant from the effect.)

Linus continues to be ravenous at home with Don. His BG levels are improving with pre-shot values in the low 300s.

**************************************************************************January 1, 2012--Linus spent a second night in the critical care hospital. The vets' concern continued to be his high BG levels and his anemia. Clinically, he was well--bright, alert, reactive, eating well, headbutting, and reaching through the bars of his cage to grab arms as people went by.

On his final PM cycle in the hospital, the care plan was to shoot his 2U Lantus, give it time to work to see how low it would take him, and then shoot Regular insulin to bring the end of his cycle down so that the 2U Lantus (unless the numbers were relatively low at AMPS) he received on the AM cycle could start its work at a lower number.

Sadly, the night vet did not follow the plan. She did not shoot the Regular insulin. I can't find my notes about the AM cycle (the vet called when I was barely awake), but my memory was that Linus's AMPS was again in the mid- to high-300s.

The vets' plans were to keep Linus between 200 and 400 mgdl to avoid both hypoglycemia and ketones from too low and too high numbers. They planned to release Linus to his local vet for continued attempts at regulations.

Don and I had hoped that the critical care vets would focus less on regulation and deal with the critical care situation of too-high BG levels. They didn't. They sent Linus home with a single cyproheptadine tablet (an appetite stimulant, with directions not to use it except in an extreme case of inappetance), and a two-week course of Doxycycline for the suspected hemobart. Don also was instructed to test Linus's urine for ketones.

The clinic should receive the results of the hemobart test from Antech on Tuesday (delayed because of the holiday). Don had planned to raise Linus's Lantus dose to 2.25 last night. Don also plans to bring Dr. Connor, his home-visit bet, back to see Linus next week. The critical care clinic recommended blood work this week to make sure Linus's Hematocit (packed cell volume, a measure of anemia) was at least holding. The last test the critical care vets did, an IStat test, showed the hematocrit down to 17%, but the vet told me we should not put any reliance on that number because the IStat test, which they rely on for electrolyte numbers, has a large range of error on Hematocrit.

In summary, what I am getting from this data:

Linus is likely anemic from hemobartonella, a flea-borne parasitic disease that is treated with Doxycycline, which he is on.

Linus's high BG levels need to be brought down. The vets were being cautious, thinking that Linus might be in Symogi rebound. Don and I disagree and believe that Linus needs more insulin. Don will be giving Linus more insulin, but use a "go slow" approach.

Linus was eating well at the critical care clinic, and we hope he will continue eating at home with Don.

Linus is not yet out of the woods.

*************************************************************************December 30, 2011-- Afternoon--I spoke today's vet, Dr. Johnston. Linus continues to do well. He is rehydrated, loves petting, and is eating like crazy. (He is still on cyproheptadine, an appetite stimulant.) Linus had a small amount of diarrhea overnight.

Since last evening's preshot, his BG levels have been in the mid 400s, with an AM+2 test of 379. Dr. J is thinking perhaps Smoygi rebound. She also is considering hyperglycemic, hyperosmolar syndrome (HHS). Because of the anemia, I asked whether a hemobart test would be prudent, and Dr. J agreed to send blood out for that test. Hemobart would require Doxycycline, on which the clinic already has started Linus.

Dr. J does not feel that Linus is at imminent risk of fatty liver given his current appetite, but that DKA remains a possibility. She asked that Don test his urine for ketones at home. Dr. J may release Linus this evening if his 12 noon and 5pm BG levels are lower.

Morning--I heard from Linus's emergency vet (Dr. Lauer) yesterday early evening. Linus is doing "very, very well." He had been receiving IV fluids and eating ravenously all day.

Linus's blood work showed no ketones, high glucose, and anemia. A blood smear revealed Heinz bodies.

Linus has been put on an antibiotic and an appetite stimulant. He is receiving 2U Lantus on his regular 5am/5pm schedule.

We will be talking with the ER vets about the possible reasons for Linus's anemia and a treatment pan for it. Although it may be as easy as being associated with the chronic disease state of diabetes, feline anemia also can be caused by other chronic medical conditions, parasites, infectious or toxic agents, or diet. We will ask about regenerative vs. nonregenerative anemia, and using the liver shake that is posted on FDMB. We also will ask whether fatty liver or ketoacidosis remains an imminent threat to Linus.

Thank you so much to the nine people who have helped DCIN raise $255 through the chip-in so far. And thanks to them and the many more offering prayers and good thoughts for Linus.

December 29, 2011--DCIN sent Linus to his new forever home on Christmas Eve. However, he has been feeling poorly and not eating. Yesterday, Papa Don had a home-visit vet in to see some of his Associates, including Linus. The vet, Dr. C., is concerned that Linus is in hepatic lipidosis and perhaps diabetic ketoacidosis.

This morning, Don will be trying to get Linus into hospitalization with a local vet clinic. (One already has turned Don down because it is booked for boarding for the New Year's holiday.) There are no nearby emergency or critical care hospitals in this very rural part of western Virginia.

DCIN will be working with Don to get Linus appropriate treatment and to pay the costs. If you can help, above is the chip-in. Without a treatment plan, I cannot accurately estimate the cost, but having been through some recent DKA hospitalizations with other DCIN-assisted cats, I know that $2K (above the amount DCIN received from the surrendering sanctuary for Linus's care) is a conservative estimate.

(I have so many expletives in my head about this situation. Linus is such a sweet boy. He should not feel this bad, or face these life-threatening conditions just when he found a loving home. ~Venita)

**************************************************************************December 24, 2011--Because Linus has grown up with and is accustomed to a large number of cats, Jenn and I decided to ask Papa Don whether he would give Linus a home. Of course, Don said YES!!

Right now, early Christmas Eve morning, Linus is in the guest bathroom of Spa Venita. He will be traveling later today, through a chain of 4 drivers, to his home with Don and Associates.

Linus is fearful, but loving. After about an hour to calm down, he was sitting on my lap and head-butting my hand. I was able to get four BG readings over 12 hours, and gave him a small dose of Lantus insulin shortly after he arrived. He does have signs of an URI, and does need to put on some weight.

I believe Linus will do quite well with Papa Don. ~Venita

****************************************************************************December 19, 2011--DCIN was given this choice--find Linus a new home immediately or he would be PTS. 3-YO Linus, born of a feral Mom and living in a sanctuary in NJ with about 50 cats, will be traveling this week to live with Don and his Associates in western VA. We would like to get some funds into Linus's account for his transport and a Welcome to the Vet visit.